A comparison of different scores for diagnosis and mortality prediction of adults with sepsis in Low-and-Middle -I ncome Countries: a systematic review and meta-analysis

Adegbite, Bayode R, Edoa, Jean R, Ndzebe Ndoumba, Wilfrid F, Mbadinga, Lia B Dimessa, Mombo-Ngoma, Ghyslain, Jacob, Shevin ORCID: https://orcid.org/0000-0003-2425-9394, Rylance, Jamie ORCID: https://orcid.org/0000-0002-2323-3611, Hänscheid, Prof Thomas, Adegnika, Prof Ayola A and Grobusch, Prof Martin P (2021) 'A comparison of different scores for diagnosis and mortality prediction of adults with sepsis in Low-and-Middle -I ncome Countries: a systematic review and meta-analysis'. EClinicalMedicine, Vol 42, Issue 101184.

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Abstract

Background
Clinical scores for sepsis have been primarily developed for, and applied in High-Income Countries. This systematic review and meta-analysis examined the performance of the quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SIRS), Modified Early Warning Score (MEWS), and Universal Vital Assessment (UVA) scores for diagnosis and prediction of mortality in patients with suspected infection in Low-and-Middle-Income Countries.
Methods
PubMed, Science Direct, Web of Science, and the Cochrane Central Register of Controlled Trials databases were searched until May 18, 2021. Studies reporting the performance of at least one of the above-mentioned scores for predicting mortality in patients of 15 years of age and older with suspected infection or sepsis were eligible. The Quality Assessment of Diagnostic Accuracy Studies tool was used for risk-of-bias assessment. PRISMA guidelines were followed (PROSPERO registration: CRD42020153906). The bivariate random-effects regression model was used to pool the individual sensitivities, specificities and areas-under-the-curve (AUC).
Findings
Twenty-four articles (of 5669 identified) with 27,237 patients were eligible for inclusion. qSOFA pooled sensitivity was 0·70 (95% confidence interval [CI] 0·60–0·78), specificity 0·73 (95% CI 0·67–0·79), and AUC 0·77 (95% CI 0·72–0·82). SIRS pooled sensitivity, specificity and AUC were 0·88 (95% CI 0·79 -0·93), 0·34 (95% CI 0·25–0·44), and 0·69 (95% CI 0·50–0·83), respectively. MEWS pooled sensitivity, specificity and AUC were 0·70 (95% CI 0·57 -0·81), 0·61 (95% CI 0·42–0·77), and 0·72 (95% CI 0·64–0·77), respectively. UVA pooled sensitivity, specificity and AUC were 0·49 (95% CI 0·33 -0·65), 0·91(95% CI 0·84–0·96), and 0·76 (95% CI 0·44–0·93), respectively. Significant heterogeneity was observed in the pooled analysis.
Interpretation
Individual score performances ranged from poor to acceptable. Future studies should combine selected or modified elements of different scores.
Funding
Partially funded by the UK National Institute for Health Research (NIHR) (17/63/42).

Item Type:	Article
Subjects:	WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WA Public Health > Statistics. Surveys > WA 900 Public health statistics WA Public Health > Statistics. Surveys > WA 950 Theory or methods of medical statistics. Epidemiologic methods WC Communicable Diseases > Infection. Bacterial Infections > Bacterial Infections > WC 240 Bacteremia. Sepsis. Toxemias
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1016/j.eclinm.2021.101184
Depositing User:	Debbie Jenkins
Date Deposited:	03 Dec 2021 14:55
Last Modified:	03 Dec 2021 14:55
URI:	https://archive.lstmed.ac.uk/id/eprint/19557

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